Wildlife Rehabilitators of North Carolina
Membership Application



NAME: MR. MRS. Miss
ADDRESS:
CITY: STATE: ZIP:
COUNTY:
HOME PHONE: WORK PHONE:
eMAIL:

MEMBERSHIP FEE $15.00
Make checks payable to WRNC, 2542 Weymoth Rd, Winston-Salem, NC 27103

The following (for a membership directory) is requested only of active rehabilitators. It will
enable us to refer callers to one another or seek help if we need it. (If you would prefer not to
receive these calls, please skip this section).


Do you have a current state rehabilitation permit? YES NO (If yes, please include a copy)
Do you have a current federal permit? YES NO (If yes, please include a copy)

Do you have a membership in the International Wildlife Rehabilitation Council (WRNC), the
National Wildlife Rehabilitators Association (NWRA), or any other state or local rehab groups?
Please list them:

Have you attended any classes, conferences or workshops on wildlife rehabilitation? YES NO
(If yes, please identify the program and group that presented or sponsored it):



Please print this form and send it and your check to the address below.

Home Page

WRNC
2542 Weymoth Rd
Winston-Salem, NC 27103